Lateral collateral ligament sprain at the ankle joint
Lateral collateral ligament sprain is the most common ankle injury. There are several ligaments that together form the lateral collateral ligament which supports the outer side of the ankle joint. The most commonly injured ligament attaches from the lower tip of the outside ankle bone to run inwards to the talus, the lower bone of the ankle joint. This is the anterior talofibular ligament. The ‘ankle bones’ aren’t separate bones as such, but are the enlarged ends of the two bones in the lower leg, the tibia and fibula, which come together to receive the talus to form a mortise-type ankle joint.
The ligament is injured when the ankle is twisted inwards with the weight of the body falling onto that side of the joint. Various grades of injury can result and the lower leg bones may also be broken in some cases. If a fracture (broken bone) is suspected then advice should be sought, usually through the A&E department, although sometimes a hairline crack in the fibula, just above the ankle, may not be obvious and will only become apparent several days after injury. If it is impossible for the patient to put any weight onto the foot, a medical opinion should be sought. More often, patients are likely to treat the ligament injury themselves with ice and a gradual return to activities, and minor sprains can respond well to this approach.
Physiotherapy can help with the more marked acute stage of the injury and at the more chronic stage when the injury hasn’t fully recovered after six weeks or more. In the acute stage there is usually an acute traumatic arthritis at the ankle joint as the ligament blends closely with the covering of the joint itself. The resulting swelling, pain and bruising will be targeted with gentle soft tissue massage and a specific massage technique called frictions to the ligament to keep it moving freely as the healing takes place. Ice and electrotherapy may be given to help to reduce the swelling and pain and to promote healing.
Early movement within the pain free range is encouraged to prevent stiffness at the ankle joint and to encourage healing within the ligament. The patient is advised to walk as normally as possible and sometimes crutches or a stick have to be given to help with that.
In the more chronic stage, some stiffness may have persisted at the extremes of movement and the ankle might still be painful after activity, playing sport etc. Some scarring will have persisted in the ligament and this now needs to be treated with frictions and manipulation to free the scar tissue and to restore normal movement. Vigorous exercise will be given to maintain the improvement and the condition usually settles quickly with one or two treatments.
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